Factual US health-care reform questions

This will probably get moved, but since I’m looking for factual answers, I’ll start this thread here.

When it comes to health-care reform I’m for the idea, but worried about the execution. Specifically, I’m worried about all of the unknowns and how it will actually work out instead of how people say it will work out. For a long time people were for and against passing reform, but yet there were multiple bills being considered so no-one could comment on specifics. Now we have a Senate bill passed and are waiting for it to be reconciled with the House. Even though we’ve narrowed things down, there’s still a lot that I don’t know about, so here are a few factual questions.

There’s debate about whether or not the bill will add to the deficit or if it will save us money.
First, some questions about the costs:
[ol]
[li]Without a public option the only cost I can see is a new bureaucracy to see who has insurance and who gets fined for not having it. Are there any estimates as to how much this new agency will cost?[/li][li]Actually, thinking about it, I think I’ve heard that low income people might get subsidized. What are the figures for how much this will cost?[/li][li]If we have a public option then the hope is it will be self-sustaining. If we can get a self-sustaining public option, I’m assuming that to get it up and running we’ll still need to use tax dollars. Are there any figures for how much that would cost?[/li][li]And finally, are there any other costs (to the tax-payer) that I’m missing?[/li][/ol]
Second, Obama says that reform won’t add to the deficit, but how can that be when it will take tax money to implement at least some of the changes?

I’ll go for your last question. The proposals involve tax increases that are projected to cover the new expenditures. The deficit is the amount by which expenditures exceed revenues. If revenue increases from the proposal exceed expenditures from the proposal, the deficit will not increase.

One of the ways they make it seem like it won’t add to the deficit …

Revenue raising provisions start right away or in the next couple of years.

The features that add cost don’t start until much later.From Factcheck.org

Visual Purple and What the … ?!?!, thank you.

This is frustrating to me because other than partisan rhetoric I’ve heard very few details from politicians and I guess my Google-foo is weak because I can’t seem to find details on the Web either.

I mean, since a lot of people, especially politicians feel so strongly about this either for or against surely there are estimates out there. The CBO is getting numbers, why not the general public?

This is all very complex. One perspective that doesn’t seem to come through in your questions is the fact that we all bear considerable costs for healthcare under the current system, through insurance premiums, co-payments, and taxes supporting the current public programs. All of these are subject to increase in the future as well, if we did not enact reforms or left it to the states to enact reforms. And some level of reforms at the state level are almost inevitable. States are starting to form high-risk pools, for example. Also, once we opened the door to federal subsidies for COBRA that will be hard to close. So the real counterfactual is not taking no action.

A good source on the web for information about the proposed reforms is the Kaiser Family Foundation website. It is not cooperating for me right now - maybe they’re getting a lot of traffic. There is a link called “Assessing CBO Analyses of Health Reform Proposals” The site is here: http://healthreform.kff.org/

ETA: Also, it’s pretty dense reading, but the CBO publishes its analyses on the web at www.cbo.gov.

Some other possibly useful information: the House and Senate bills have different levels of subsidy to help low income people buy insurance, so different costs for that on the two bills. Both bills expand Medicaid, but the incomes levels are different. Also, with the Medicaid expansion, some of the costs will be shifted to the State.

The following link might be helpful just to understand the content of the two different bills:Comparison of House and Senate Bills (PDF)

Just to point out, at this point the ‘public option’ is dead in the water - both sides (and Obama himself), have basically acknowledged it isn’t possible because they can’t get 60 Democrats in the Senate to vote for it. It will almost certainly be removed before the final bill passes.

Here is a short, excellent, easy-to-read and non-partisan discussion of whether the healthcare bill will reduce healthcare costs from PolitiFact: http://www.politifact.com/truth-o-meter/statements/2009/dec/18/barack-obama/obama-said-health-care-reform-will-reduce-cost-hea/

In summary, what they conclude is that there are three ways of looking at whether the healthcare will “reduce costs”:

  1. Whether it will reduce people’s premiums: Yes, it will slightly reduce people’s average premiums.
  2. Whether it will reduce the deficit as a whole: Yes, it will slightly reduce the deficit.
  3. Whether it will reduce spending on healthcare specifically: No, spending will continue to increase, but in the long-term the bill is expected to reduce the rate of the increase in spending.

I completely agree that our current system is broken and change is needed. I’m just unhappy that response seems to be OMGweneedhealthcarereform now! Now! Now! Worry about the details later, rush this through now!
I want to know what we’re getting into.

Thank you for the links

ETA: Thanks also Visual Purple and The Great Philosopher for the links you posted.

At the risk of getting partisan, the Demcrats are running the show and it’s pretty clear they don’t want the general public to know all of the details.

See post #5, the CBO publishes their analyses on their website.

The general public is incapable of understanding “all of the details.” There’s no shame in that. We don’t understand all of the details of defense policy, or No Child Left Behind, or how interstate highways are funded, either. Estimating healthcare costs is complex and will necessarily be done with uncertainty. 28% of Americans have a college degree, and of those plenty of them have one in something that doesn’t prepare them to understand healthcare economics. The complexity of the issue is no evidence that anyone is hiding anything.

If you consider an international context, you soon discover there is nothing to hide.

The scare tactic of ‘something being hidden’ only works as an argument if the parameters remain parochial.